What is new in the updated 2022 Coronary Artery Disease-Reporting and Data System (CAD-RADS™ 2.0) consensus document?

Abstract

In recent years, coronary computed tomography angiography (CCTA) has made significant advances in both imaging technology and clinical validation of CCTAderived interpretations. During this period, imaging protocols were optimized according to image quality, diagnostic accuracy and radiation dose. Indeed, interpretation standards are as important as image quality. In general, standardized reporting helps reduce variability among image interpreters. Because of standardized reporting, it is always expected to be beneficial to link the final opinion in the CCTA report with recommendations for subsequent patient management. The first Coronary Artery Disease Reporting and Data System (CAD-RADS) was launched in 2016 to standardize the reporting system for patients with suspected or known coronary artery disease undergoing CCTA in an outpatient, inpatient, or emergency setting, and was created for the purpose to guide the next possible pathways in patient management (1). The main goal of CAD-RADS was to create standardization of report terminology for CCTA results in order to improve communication between image interpreter and referring physicians in a clear and consistent fashion and to better guide clinical decisionmaking. The proposed CAD-RADS classification was applied on a per-patient basis and represents the highest-grade coronary artery lesion documented by CCTA. The implementation of the first CAD-RADS system included application in two different clinical settings (patients presenting with stable chest pain and patients presenting with acute chest pain), description of the most severe coronary artery luminal stenosis (for vessels ≥1.5 mm in diameter), and three modifiers (stent, graft, and vulnerability). In July 2022, a new expert consensus document on Coronary Artery Disease-Reporting and Data System (CAD-RADS 2.0-2022) was published by the Society of Cardiovascular Computed Tomography in collaboration with the American College of Cardiology, the American College of Radiology and the North America Society of Cardiovascular Imaging (2). New additions for the updated expert consensus recommendations include an emphasis on the reporting of ischemia findings and coronary plaque burden on CCTA. Below are key updates from the consensus recommendations.